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PERMITTEE NAME/ADDRESS (Include Fae!liry NmnNLoroHOn yDigerer9 <br />NAME pr:gllP.•4 `;i:i:rv6~ Lr•C. <br />ADDRESS ~ ; n !"i r ,_ r q <br />d. v. ~,:. 1",] <br />FACILITY ` ~• A ! :• :-.:~ ~ i r i o <br />LOCATION <br />NATIONAL POLLIfTANr DISCHARGE ELIMINATION SY5rEM (NPDES) FOfRI ApprOVed. <br />DISCHARGE MONITORING REPORT (OMR) OMB No. 2040-0004 <br />1 ~ .". <br />PERMIT NUMBER DISCHARGE NUMBER _ ` <br />MONITORING PERIOD 'L" =i. ~ L' ~: L~:1 <br />YEAR MO DAY YEAR MO DAY <br />FROM i 1 TO J: !" ~ :. ,~ i `-:.c 9i-.;.C '°~"~'= <br />',NOTE: Read Instructions before comoletlnc this form. <br /> QUANTITY OR LOADING QUANTITY OR CONCENTRATION NO. FNEOUENC SAMPLE <br />P <br />R EX of TYPE <br />A <br />AMETER AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS ANALySlS <br />'iL .46.r ;f-:tA"~'-. SAMPLE ~ '~:.rt^ ~ "UJ (s 4: ::".: -: .",r {: ~t. :..: <br />i ~ ~ 1 R L MEASUREMENT <br />J L li .,. 2~Y ...: <br />~ }:J=L ~II`":. <br />` <br />I' e~TA <br />`~ <br />`~' ~ .}'T'M Y}t.. it }.L TSM <br />.' I. J " : I' G i J . ~' a f. , AEQ131F#F,K7~IJ'f" ~' S• ..-!i .~ r f~I~~C' '~! k iC <br />` ' I r . r) .`: <br />- <br />. ,,i r~ ~ <br />~a <br />~~' ~; ; : _ <br />SAMPLE <br />MEASUREMENT <br />SAMPLE <br />MEASUREMENT <br />SAMPLE <br />MEASUREMENT <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />MEASUREMENT <br />~ `'i~ IY"v~= t'om' k ~ '^~ v~~,x}:'~ i ,{`• . ~ : ~ti :-,~$'+* ,} . { ; a ~,. s . ,,s r~ <br />~~a M~ :~, h.f~. ~ ~ ~ t~ <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I CertAy under penaly W law Nat this document and ell ednchmems ware ~ TELEPHONE DATE <br />prepared untler my Oirecaon or supervision in exordance with a system dosigned <br />to assure Mel qualified personnel pmpedy gather entl evaluate Me Inbmwoon ~y~~ ~ - / / - _ <br />w. GJrdoD Peters submitted. awed an mylnqulry of the pereon or parsons who marege the eyulem, %'~ !/if~~ 97O-SZh-l1 /LC1 O1 07 25 <br />or Moae persoru direuby reaponeible br gaNedng the IrXOnretlon, Me iMOrtnNOn <br />President/General Manager eubmittetl ie,to Me beet Of mylegwietlge antl belief, hue. accurate, antl cgmplele. SIGNATURE OF PRINCIPAL EXECUTIVE <br />I em aware that Mere ere signifignl penalties br submitting hake informeaon, OFFICER OR AUTHORIZED AGENT <br />TYPED OR PRINTED Includin Me ssibili of ine and lm risonment for knows vlolafions. NUMBER YEAR MO DAY <br />n!\1...•-. ~r.. ...n cVDI n\IATlnal nr nrJV \/Inl aTIn1,IC ro..G...,.,.... ..u elrenA.nn..M bu.ut <br />~J,"~i, L..., i ~I: _.-. iiil.iiV '~,r P.~' °i.`< ..r:, i;`_ ....'.Li it ~'F... _:• C- '~- i- ~Y~r- <br />I' <br />,9. :`i ;)r' Pn C: .)F ': ° UISF"^;. '~T.; Ir. `'dn 1. R..1. T:!` "'t :~ITO~i':G - I. ~. 7. ..:L ... - ' ... (")• <br />EPA Form 9320.7 EV /J9) revious a Itions may be used. ~ - ~ y • (~ R i 0 ? ~ 0 rl ~. T t T}il$,IS A 4-PART FORM PAGE OF <br />'~ - <br />